肺隔离症患者53例临床诊疗分析

发布时间：2018-05-06 05:04

本文选题：支气管肺隔离症 + 体征和症状　；参考：《中国全科医学》2017年36期

【摘要】：背景肺隔离症是一种罕见的先天性肺发育异常疾病,临床误诊率高。目的总结肺隔离症的临床特点、影像学表现、诊断以及治疗体会,以降低误诊率。方法收集2008-01-01至2016-10-01济宁医学院附属医院收治并确诊的53例肺隔离症患者的临床资料,对其临床特点、影像学表现、诊断、治疗以及预后进行分析。结果 53例患者中,临床表现为咳嗽37例、咯血23例、咳痰20例、发热12例、胸闷8例、胸痛6例、无明显症状者9例。病变位于左下肺34例、右下肺17例、左上肺2例。影像学表现为实性肿块影19例,囊状影16例,不规则斑片状影12例,空洞4例,肺不张1例,胸腔积液1例。隔离肺的供应血管34例来源于胸降主动脉,17例来源于腹主动脉,1例来源于胸主动脉和膈肌动脉,1例来源于腹主动脉和左膈上动脉。53例患者确诊30例,23例出现误诊,误诊率为43.4%;48例行胸腔镜下肺叶切除术,术后继发肺部感染1例,2例咯血患者行异常动脉介入栓塞治疗,余3例行对症治疗。所有手术患者未再复发。结论肺隔离症临床表现无特异性,误诊率高,增强CT和CT血管造影(CTA)是临床常用的诊断方法,确诊后应积极手术,胸腔镜下肺叶切除术是临床最有效的治疗方法。
[Abstract]:Background Pulmonary sequestration is a rare congenital pulmonary dysplasia with high misdiagnosis rate. Objective to summarize the clinical features, imaging manifestations, diagnosis and treatment of pulmonary sequestration in order to reduce the misdiagnosis rate. Methods the clinical data of 53 patients with pulmonary sequestration admitted to Jining Medical College affiliated Hospital from January 2008 to January 10-January 2016-2016-01 were analyzed. The clinical features, imaging manifestations, diagnosis, treatment and prognosis were analyzed. Results among 53 cases, 37 cases were cough, 23 cases were hemoptysis, 20 cases were expectoration, 12 cases were fever, 8 cases were chest tightness, 6 cases were chest pain, 9 cases were without obvious symptoms. The lesions were located in the left lower lung in 34 cases, the right lower lung in 17 cases, and the left upper lung in 2 cases. Imaging findings included solid mass in 19 cases, cystic shadow in 16 cases, irregular patchy shadow in 12 cases, cavity in 4 cases, atelectasis in 1 case, pleural effusion in 1 case. The supply vessels of isolated lung in 34 cases originated from descending thoracic aorta in 17 cases from abdominal aorta in 1 case from thoracic aorta and diaphragmatic artery from 1 case from abdominal aorta and left superior phrenic artery. The misdiagnosis rate was 43.4% and 48 cases underwent thoracoscopic lobectomy, 1 case of secondary pulmonary infection and 2 cases of hemoptysis were treated with abnormal arterial embolization, the remaining 3 cases were treated with symptomatic therapy. No recurrence occurred in all patients. Conclusion the clinical manifestation of pulmonary sequestration is nonspecific and the misdiagnosis rate is high. Enhanced CT and CT angiography (CTAA) are commonly used in clinical diagnosis and should be operated actively after diagnosis. Thoracoscopic lobectomy is the most effective treatment.
【作者单位】：济宁医学院;济宁医学院附属医院呼吸内科;
【基金】：山东省医药卫生科技发展计划项目(2016WS0176)
【分类号】：R563

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